Individual
SAMUEL BRYAN VALDIVIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 N GRAHAM ST MEDICAL OFFICE BUILDING 2, SUITE 220, PORTLAND, OR 97227
(503) 413-6200
Mailing address
1701 SW COLUMBIA ST APT 404, PORTLAND, OR 97201-2592
(602) 403-5363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213719
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/25/2020
Last updated
10/28/2022
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